General Principles of the Hybrid Approach in Hypoplastic Left Heart Syndrome

Abstract

Congenital heart disease remains the most common form of birth defect and occurs in ~1 % of all live births. Hypoplastic left heart syndrome (HLHS) occurs in 2–3/10,000 live births in the USA [1]. It was uniformly fatal through the 1970s until the Norwood surgical palliation was proposed in 1980 [2]. When done properly, this operation, and its Sano modification, achieves a tenuous but stable circulation as a first step in palliation for HLHS. Less traumatic neonatal palliation has since been pursued as an alternative to the Norwood operation. Gibbs et al. first described neonatal stenting of the arterial duct combined with pulmonary artery banding and atrial septectomy or septostomy as an alternative palliation for HLHS in 1993 [3]. Since that time hundreds of articles have been published describing variations on technique and outcomes from this so-called hybrid approach to HLHS.